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State funds for medical training in limbo

University of Minnesota Medical School officials and clinic administrators throughout Minnesota say the state will find it difficult to retain young doctors without continued government support.

State and federal funds pay most of the training costs for doctors. But in reaching a budget deal last summer to resolve the state government shutdown, Gov. Mark Dayton and Republican legislative leaders slashed training funds from about $58 million to about $31 million.

Health leaders say it's important to restore the funding because to have enough doctors, Minnesota must grow train its own.

Every year, about half of the University of Minnesota Medical School's students stay in Minnesota for their residencies. This year, about 100 university graduates were placed in residency positions in Minnesota hospitals and clinics.

The number of residents gives the state a good idea of how many new physicians it will have, because doctors usually start their careers where they train.

To maintain the flow of newly trained doctors, the state subsidizes training programs both for medical students still working on their degrees, and for residents. The programs for doctors-in-training are particularly important in smaller cities and towns, where there it is harder to recruit doctors to fill the growing shortage.

"We have evidence that suggests it actually makes a difference," said Dr. Aaron Friedman, dean of the University of Minnesota Medical School.

Friedman said many physicians in Minnesota will be retiring soon. With that in mind, he said it is, essential to offer training across the state if Minnesota wants to have enough doctors in the future.

"We do not import physicians. So we have to understand that if we're not giving people the opportunity to see the broad opportunities that exist here, they're not going to come from California to do this, and they're not going to come from Florida to do this. We have to do it," Friedman said.

After medical students earn their degrees, they must serve a residency before they can become licensed to practice medicine. It's the part of a doctor's training that doesn't involve taking out another student loan.

The federal government pays for much of the residents' salaries, and the hospitals that employ them cover some of the training costs. The state subsidies — called Medical Education and Research Costs (MERC) — have been around for 15 years to help maintain the training programs.

The state cuts to the subsidies aren't the only concern about how doctors will be trained in the future. Cutting federal funds for residencies are also seen as a way to reduce spending.

State and federal cuts for training couldn't come at a worse time, said Teri Fontenot, chairwoman of the American Hospital Association.

"The demand for health care continues to grow because the population is graying, and because technology advances and other things are providing longer lives or the ability to manage chronic diseases," said Fontenot, who visited Minneapolis last week to meet with the leaders of area hospitals and other health care organizations. "At the same time the amount of money available for that is shrinking."

In Minnesota, there's a chance some of the medical training funds will be restored before the Legislature adjourns this spring. But already, some program administrators are telling the University of Minnesota they can't take on as many trainees. Others wonder if they'll even be able to exist.

"We're looking three or four years out and don't know if we can sustain the subsidies," said Ann Bussey, vice president of the Essentia Institute of Rural Health in Duluth. It saw a 45 percent cut in its training subsidy.

Essentia Health and St. Luke's Hospital use some of their state funding to support the Duluth Family Medical Residency program, which invites 10 medical residents each year to train in rural Minnesota, where there is a shortage of doctors.

A national county rankings project released data earlier this month showed that in two dozen Minnesota counties, each primary care doctor would need to serve more than 1,000 people. That's far more than the 630 patients per doctor recommended by health advocacy organizations.

Bussey said the Duluth Family Medical Residency can't help the state improve those numbers without state money.

"We're limping through this year, we're trying to create a new model for next year, and it's so vulnerable," she said. "Is that what Minnesota wants? Do they want to train all their residents in Minneapolis-St. Paul? This is the state's investment in primary care, and especially to prepare this rural-ready work force."

In the Twin Cities, officials at Regions Hospital in St. Paul and Hennepin County Medical Center in Minneapolis avoided cutting residency positions this year in hopes that the cuts would be only temporary.

"We don't feel [cutting residencies is] a good strategy for either Regions Hospital right now or the state," said Dr. Carl Patow, who directs the Health Partners Institute for Medical Education, which coordinates training programs at Regions. "If we look at the change in the demographics of the population of the state, we're going to need thousands more physicians over the next decade than we have now."

Patow said the state cuts did force Regions, which lost more than half of its subsidy, to cut some training staff and reduce faculty compensation for teaching.

Patow and Dr. Michael Belzer, the Hennepin hospital's medical director, said leaders are concerned about future funding for training.

"There's certainly been a lot of conversation, a lot of what-ifs, a lot of discussion about what we're going to do if MERC cuts were sustained," Belzer said.

Without the state and federal funds, Belzer said, the Hennepin medical center would not be able to maintain its role as a teaching hospital.

"The efficiencies of delivering care are altered by having medical students and residents," he said. "If you were doing it alone you would be able to get through the procedure or the interview or the exam a lot quicker than if you had students."

State lawmakers will decide in the next few weeks whether to restore cuts to the medical training programs. Dayton has said he wants to partially restore the cuts, but GOP leaders so far haven't moved to do so.